Here is my Biopsy- Very bad or ?

[Yukonjack]

Hi - here is my Biopsy. Im 57 . Strong Family history of PC . Recently diagnosed. Not sleeping well ! Pacing the floor.... . CT scan is clear, and bone scan is clear- no issues detected. Can anyone help me with some knowledge here ? MRI Tomorrow ( in Canada 1.5T MRI , im getting). Doctors tell me I need to make a decision on treatment a couple months ... I would like to do it sooner to treat issue and prevent as much spread as possible ! No spread detected thus far . Thanks for your input and kindness ..... Yukon jack

[Justfor_]

60% pattern 4 and PSA 3.6 don't go together, unless you belong to some few % of the most unlucky of us. If you could upgrade your MRI scan to 3T multi-parametric MRI then you could get some better view of what is happening.

[Yukonjack in reply to Justfor_]

I think they call it grade 3 . I will upgrade the MRI if the Doctors need it. May do it myself for sure ! I don understand about the 60% and pattern 4 , what your saying . .. could you expand ? My PSA is on the lower side. Gland is 27 cc's .

[Justfor_ in reply to Yukonjack]

I am not saying, just quoting from your report. It reads:

"Percentage pattern 4 accounts for approximately 60% of tumor".

Someone has underlined the two figures as they are the most important pieces of information contained there in. After them your Gleason Score (GS) has been staged to 4+3=7 (also denoted as 7b to distinguish from 3+4 =7a) because pattern 4 is the prevalent one. Usually, 7b is accompanied by higher PSA. Ask your doc about it.

[Yukonjack in reply to Justfor_]

Thanks for your input! I sure appreciate it. Actually I underlined the '4 and the 60% ' on the report , when I was discussing this with the Urologist . He said that if my PSA was 2 or lower he would be worried about aggressiveness , But because it is at 3.8-4.0 , and the size of the gland and other features, plus my CT scan and Bone scan being clear... was reassuring and I likely dont have the most aggressive form . But its anyones guess , until the gland is actually extensively biopsied ? I almost wish my PSA was higher !? I friend of mine had a 4+3 tumour with a PSA of 6.5 . He had a Radical 5 years ago...doing ok now . I hope my story is like this !

[Currumpaw in reply to Yukonjack]

Hey Yukonjack!

Justfor_ gave you excellent advice. A former urologist, while pointing out "spots" on a 1.5T MRI image of my prostate on his laptop that he was unable to tell the difference between a lesion and scar tissue. If such is the case, might a small lesion also be missed with a 1.5 but be be readily visible when a mp 3.0T MRI is for the imaging? Good reconnaissance wins battles.

Currumpaw

[doc1947g in reply to Yukonjack]

73 y.o. with Lymphoma NH Marginal Zone and many Acute Chronic Diseases.

*Prostate-specific antigen (PSA)*

*Pré-Hormonothérapie*

4.23μg/L (2001/07/18), 2.2 μg/L (2002/07/23), 1.8 μg/L (2006/07/04), 2.2 μg/L (2008/09/22), 2.4 μg/L (2009/05/20), 2.05 μg/L (2011/08/26), 2.25 μg/L (2012/08/13), 2.05 μg/L (2013/08/06), 2.77 μg/L (2014/07/28), 3.84 μg/L (2015/07/06), 1.97 μg/L (2016/06/30), 3.89 μg/L (2017/06/13), 6.8 μg/L (2019/09/10), 11.7 μg/L (2019/10/28), 13.7 μg/L (2020/01/08), 16.7μg/L (2020/03/02), 20.4 μg/L (2020/04/06),

*Per-Hormonothérapie*

1.76 μg/L (2020/05/04), 8.58μg/L (2020/05/27), 0.18 μg/L (2020/07/29),

*Post-Hormonothérapie*

0.03 μg/L (2020/09/15), 0.01 μg/L (2020/12/15), 0.01 μg/L (2021/02/11)

*Testostérone*

*Pré-Hormonothérapie*

10.30nmol/L - 294.19ng/dL (2020/05/04), 15.2nmol/L - 438.04ng/dL (2020/05/27),

*Per-Hormonothérapie*

< 0.2nmol/L - < 5.768ng/dL (2020/07/29),

*Post-Hormonothérapie*

< 0.2nmol/L - < 5.768ng/dL (2020/09/15), 0.3nmol/L - 8.6455ng/dL (2020/12/15), 0.4nmol/L - 11.5214ng/dL (2021/02/11)

Prostate went from 24.7cc to 45.86cc.

2020 March 3rd I had 6 cores out of 12 positive on the right side at 85% G4 with EPE, then on a Special pre-RT Scan they found multiple tumors on both sides.

I am in the Ufavorable Intermediate Risk group with a G(4+3=7) Grade 3.

I got and injection of Eligard 45mg/24weeks on April 4th 2020 that was screw-up so I did not get the benefit of Pre-RT 8 weeks of ADT. And on Casodex 50mg/I.D. X 30 days.

So I have been on Lupron Depot 22.5mg/12weeks X 2 from 2020 May 31st &2020 Aug 24th to 2020 Nov 16th and on

VMAT-RT 3Gy X 20Fx in June 8th 2020 to July 7th 2020 and my

PSA = 0.01µg/L and my

Testosterone = 0.4nmol/L or 0.1154µg/L or 115.368ng/L or 11.5368ng/dL

On Feb 11th 2021.

2021/03/11 and 2021/03/12 R/V Haemato-Oncologist. PET-CT Scan sid not show ANY sign of PCa or Lymphoma.

BTW I too am a Cannuck from Quebec, on the North Shore of Montreal.

[doc1947g in reply to doc1947g]

What I do not understand from your pathology report is that at one plac, they mentionned 12 scores biopies like me.But further down they talked about 3 cores, but it should be 2 cores.

The way mines were done was:

(R)Base Mid & Lateral= 2 cores

(R)Middle Mid & Lateral= 2 cores

(R)Apex Mid & Lateral= 2 cores

(L)Base Mid & Lateral= 2 cores

(L)Middle Mid & Lateral= 2 cores

(L)Apex Mid & Lateral= 2 cores

Total = 12 cores G(4+3=7)Grade 3 85%

Multiple tumors spread in the 2 lobes

VMAT-RT 3Gy X 20 Fx= 60 Gy an

Lupron Depot 22.5mg/12weeks X 2.

PSA = 0.01µg/L

[Gemlin_]

Similar to my biopsy. Could be much worse. You have intermediate risk for spread. No EPE i.e. contained within the capsule which means that either surgery or radiation could be curative for you. I selected surgery. If you do nothing the risk of dying from it is 20% within 10-15 years. Take your time to decide treatment. A few month is ok. This cancer grows slow.

[Yukonjack in reply to Gemlin_]

Gemlin.... My father passed away from it at 67 . Im 57 and just retired. I think I have PTSD from it ...taking him back and forth from hospital. with my scores and biopsy with surgery or BT my chances are OK ? Scared to death ! ....sorry !

[Gemlin_ in reply to Yukonjack]

The chance of dying from your prostate cancer is very, very low. Your problem now is to decide which treatment that is best for you. Try to focus on the treatment options.

[AlanMeyer Moderator]

Hello Yukonjack,

When considering your treatment, one of the most important considerations is the knowledge, skill, experience, and commitment of the doctor who performs it. A really good doctor will likely have higher average rates of cancer cure or control, and lower average rates of adverse side effects, than average doctors. And remember that the average doctor is, well, average. We know that both surgery and radiation have high success rates for men with locally confined cancer, which is what you appear to have. I think I'd pick a top surgeon over an average radiation oncologist, and a top rad onc over an average surgeon. For myself, with a Gleason 4+3 cancer, I was treated by a very good woman doctor at a very good hospital with high dose rate ("HDR") brachytherapy + external beam radiation + ADT at age 57. I'm now 74 years old and have had no treatment since 2004.

To see patient reports of their experience with different treatments, have a look at "You Are Not Alone Now" ( yananow.org ). To search for specific treatments try ( yananow.org/query_stories.php ). For information about doctors and hospitals try searching Google for "best prostate cancer treatment in Canada", or similar searches. Famous doctors and hospitals are usually good choices though even with them, results are never perfect. Some local and relatively unknown doctors may also be good. Sometimes, when you talk to a doctor, you get a gut feeling that this person is honest, knowledgeable, and truly cares about his patients. Sometimes you don't get that. A famous prostate surgeon may do 200 prostatectomies a year and has seen everything. Another guy with a degree in urology may do 3-4 per year. I was offered a prostatectomy by a guy like that who I found out specialized in female incontinence. He did a very painful and inaccurate digital rectal exam on me. I passed on his offer and found a very good rad onc instead.

If you are not yet metastatic, and you don't appear to be, you have an excellent chance of a successful treatment that eliminates prostate cancer from your future. That's the ideal outcome and it is most likely to be achieved by the very first treatment. So try to make it a good one.

If your first treatment does not cure you, you are not yet condemned to death from PCa. There are other treatments that, in some cases, can cure you, and some treatments that, in some cases, can control the cancer for years or decades to come.

I won't say "don't worry". Only strange people and supermen can do that. I won't even say "don't panic". Most of us at least occasionally wake up at 3 am into a panic attack. That's normal too. But each individual panic attack does eventually end and leave you still alive and pretty much in control of things. You're still alive. You've still got a lot of life ahead of you. You can still make that life, or at least most of it, as good as it ever was.

Best of luck,

Alan

[leach234]

Since it’s contained to the prostate have the surgery and remove it. You should be fine. You can always follow up with radiation down the line if you need it. Find a surgeon who has done thousands of robotic surgeries. Practice makes perfect. Travel if you have to since it’s only an overnight surgery. Follow up with your local Urologist.

[CarverD]

Hello Yukonjack.

I remember how my brain reacted to the news that I had PCa - not well. Took me several weeks to wrap my head around that news and get down to the business of research. Try to relax a bit, you have some time to make a decision and should not rush to treatment until you are sure it is the right one for you.

I had several friends and relatives who were in the camp of "get it out, get it out right now" and took the route of RP. Some are doing well, others are still wearing pads a year after surgery. There are a lot of options available for intermediate risk cancer that is capsule contained. My advice is to focus on the side effects of the various treatments - although I looked at the best case scenarios I also looked at the worst cases and determined what I was willing to live with for the rest of my life (I'm 63; have parents lived into their 90's). In the end I chose radiation, HDR Brachytherapy, over surgery or focal treatments (with tumors in both lobes I was not a good candidate).

As you are narrowing down your treatment options look for the best doctor(s) that you can find and ask for consultations. The more a doctor practices their craft the better the outcomes. I personally left my area and travelled 3 1/2 hours to work with a doctor that had introduced HDR-BT to Western NY decades ago. I'm a little over 5 months posts radiation and doing wonderfully.

I wish you the best on this journey. Remember that in the end it is you that must live with the outcomes of the decisions you make - be sure they are as informed as possible. Feel free to drop me a line if you'd like someone to talk with that has recently been where you are at the moment.

Regards,

- doug

[bobdc6]

I skipped surgery and it's many side effects, and went right to radiation in 2017, so far, so good.

Bob, G4+5, Proton, 18 month adt

[Hidden]

Ask the pathology lab to box up the slides and send them to Johns Hopkins for a second opinion. Very commonly done and insurance covers it. Then when you get the fax of the results speak with the pathologist on duty. A great service. pathology.jhu.edu/departmen...

[Jordache]

Hey Yukonjack,

Don’t panic....I did at first.....read...u tube webinars.....yours were similar to mine! I’m 53 and did HD brachytherapy at MSK. Went very good and now I will get 5 daily doses of external radiation and a shot every 3 months for 18 months. Dr. said caught it early and could live to 80-90 as my grandma was 101. From his lips to Gods ears!

[j-o-h-n]

Yu-Kan-Jack............ We all had the same shit you're going through when we found out we had Pca. They all say (and I do too) "do not panic".... but we panic (it's the natural thing to do). Take your time to find out what procedure(s) would be best for YOU!!! Make sure you get the best doctors to take care of you. Tell us your location and ask here for any good references in your area. With all the new meds being introduced to fight Pca you will be around until your 90 years old and still being a pain in the ass to your wife. Take the time to live and laugh............... and keep posting here..... And God Bless your Dad as he looks down at you........

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 03/14/2021 7:02 PM DST